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The more recently a patient received a spinal injection with the contaminated steroid implicated
in a nationwide outbreak of fungal meningitis, the higher the risk of developing the disease,
federal health officials are reporting.

People injected with the contaminated drug within the past six weeks — since Sept. 11 — might be
at the greatest risk, and extra monitoring should be considered for them even if they have no
symptoms, according to an advisory posted online Tuesday night by the Centers for Disease Control
and Prevention.The drug was recalled on Sept. 26.More-recent injections might carry higher risk
because the drug was older and had grown more and more contaminated as it sat on the shelf with the
fungus multiplying inside the vials.

Even so, the risk of developing the disease remains relatively small, officials reported.

So far, 317 people in 17 states, including 11 in Ohio, have been infected in the outbreak, and
24 have died.The disease has been traced to three lots of methylprednisolone produced by the New
England Compounding Center in Framingham, Mass. About 14,000 people have been injected with it.

Preventive treatment with antifungal drugs is not being recommended because the drugs can have
severe side effects. Instead, experts say, high-risk patients with no symptoms should be monitored
and treated only if tests find a sign of infection.

The advisory suggests two options for monitoring people who were exposed to the contaminated
drug within the past six weeks but who have no symptoms. The first option is to keep watching for
symptoms and to perform a spinal tap if they occur. Meningitis symptoms include headaches, stiff
neck, dizziness, fever and sensitivity to light. If the spinal tap finds more than five white blood
cells in the spinal fluid — a sign of infection — treatment should begin.

The second option is to perform a spinal tap even if there are no symptoms. If there are five or
fewer white blood cells, there should be no treatment, but the patient should still be
followed.